Good Therapy and Where to Find It

tl;dr: Therapy is a collaborative relationship built on trust, meant to improve mental health problems. It is worth seeking if you are distressed or restrained by internal thoughts or emotions. Pre-emptively interviewing possible therapists and understanding how therapy works will help you find good therapists. Otherwise, therapy should make you feel hopeful about the future and not more stressed.

Therapy is a critical piece of any effort to maintain good mental health, even outside of recovering from executive dysfunction. Unfortunately, there are often horror stories of finding ineffective or outright harmful therapists. These, along with harmful personal experiences, can make the idea of seeking therapy scary to many people. Because of this, it is worth understanding what therapy looks like, recognizing when it would be helpful, but most importantly… It is critical to know what to look for and what to avoid.

1. What is therapy?
2. How do I know if therapy would be good for me?
3. Good therapy is built on trust.
4. Interview your therapist!
5. Healing takes time, effort, and communication.
6. How do I know if I’m not getting good therapy?
7. I’m ready to look for therapy. Now what?

What is therapy?

You might think you know the answer to this question, but a surprising number of people don’t. People often expect therapy to be an answer to their questions and concerns, but this isn’t the case. Instead, therapy is a collaborative relationship in which the therapist typically takes a back seat, expecting you to speak more. This is to allow you space to express your concerns, stresses, and experiences.

In the most common talk therapy, you typically speak about troubles you went through since the last session. These troubles become a “jumping-off” point to discuss unhealthy thought patterns or the concerns you came to therapy for. Sometimes, when you know how to phrase them, you can bring up your primary concern directly. In all cases, hearing how you speak allows the therapist to understand your perspective and target your specific challenges.

Therapists use many techniques, most often Cognitive-Behavioral Therapy. However, many other types of therapy exist with many approaches, addressing your mental health through various models. Other types of therapy target specific challenges, such as speech therapy or occupational therapy. In general, these treatments work to relieve symptoms of mental health challenges and improve your daily functioning.

How do I know if therapy would be good for me?

Therapy is useful to help manage distress or mental “barriers” preventing you from acting the way you want. Distress is a common challenge, but can have many possible causes. Common causes for distress that therapy can help are unhealthy habits such as addictions, intense or disruptive emotions, and persistent negative thoughts. Grief over losses or major life changes are also common reasons to need support. Therapy is particularly helpful when these problems happen regularly or are prolonged, but is also useful when they are temporarily intense.

Mental barriers are the other most useful area therapy can support. Difficulty breaking harmful habits or addictions is one of the most obvious examples of this. However, this can also include problems such as anxiety restricting actions. You might feel anxious around social situations, or not be sure how to approach them. These are also forms of mental barriers which therapy is very suited to helping.

Ironically, anxiety around therapy is often a strong indicator that it would be worthwhile. Many anxieties around therapy center around fears and lack of trust in other people or health systems. While these stem from solid reasons, good therapy is far more available than you might think! Additionally, the best way to stem these anxieties is to understand how to find good therapy… and avoid bad therapy.

Good therapy is built on trust.

This is the very first and most important point to understand. Therapy is a collaborative relationship, and that means your therapist needs to be trustworthy. Ideally, you should be able to feel safe sharing anything (or nearly anything) with them. However, this type of trust needs to be earned and it is normal not to have it right away.

Several key points are important for safety and trust. Your therapist should try to listen and understand you without judgement. This involves validating your emotions even if they don’t agree with them or your actions. When they do disagree, they should do so respectfully and not make you feel bad for it. Even if they don’t know what you are talking about, they should freely admit that and try to learn.

During therapy sessions, you should always feel “in the driver’s seat.” If they suggest actions, it should be an option and not an action you are forced into. This means you maintain control of your own treatment. Ideally, therapists should also check in with you and ask your opinions and thoughts about the treatment. Not only that, but they should try to make adjustments based on these thoughts and opinions. Beyond this, you should also be able to feel comfortable asking them questions! With that said…

Interview your therapist!

Note: These particular suggestions are most suited to people seeking healthcare they will be paying for. In many countries with public healthcare, they are less important as you will not be spending as much money trying out therapists. Similarly, you may not have the opportunity to interview them before the first session or look up information about them. In this case, treat the first session as your initial “consultation” and interview of the therapist!

When initially looking into a therapist, finding information about them should be easy. This should include information about their licensing, fees, billing, and informed consent forms. Additionally, check if they have endorsements or reviews from other therapists and previous clients. This won’t tell you if a therapist is good or bad, but will give you a first impression.

After looking into them online, ask for a phone consultation! This is a short free meeting (around 15-30 minutes long) where you can ask questions about their practice. During this consultation, you should make sure they provide accessibility options and are willing to help you understand their documents. This includes any forms you found on their website that confused you or had accessibility problems. If they refuse to do a consultation, that is a major red flag: A consultation is important for building trust.

There are several other important questions to ask here. Asking about their experience and knowledge about your concerns is worthwhile, to make sure they can properly help you. Any treatments they provide should be evidence-based, especially if they target your specific concerns. Additionally, you can ask about their approach to diagnosis. They should be willing to explain any diagnoses they provide and take your thoughts into consideration when providing a diagnosis.

Healing takes time, effort, and communication.

Therapy is not a simple, quick, or easy process. While a good therapist should provide multiple resources and possible solutions, you ultimately will need to make changes yourself. You can think of this as your therapist providing a toolbox, while you use the tools to improve your life. Additionally, since therapy is a type of relationship (an “alliance” against mental problems), communication is critical. If you have communication difficulties, needs, or even preferences, it is worth telling your therapist about this. These needs should be respected for the therapeutic relationship to work well.

In general, it is important to communicate about anything that can impact the therapy. This might include cultural information about yourself, which your therapist should respect even if you do not explain it fully. This cultural information could be based on where you grew up or some aspect of your identity. It could also include discussing problems and potential problems with the therapy, such as power dynamics between you and your therapist.

Remember, even when communicating well, it takes time to resolve problems. Therapy typically takes anywhere from 1-3 sessions for you to start trusting even a good therapist. Additionally, more substantial problems such as trauma can initially feel worse to talk about, though you should feel better soon afterwards. Progress can sometimes happen immediately, but typically takes at least a month to see. Fully achieving goals more typically takes multiple months or longer. Progress should never feel rushed, either. Changes happen in your life and the timeline of therapy needs to adapt to these changes.

How do I know if I’m not getting good therapy?

This is one of the most important parts of finding a therapist. Fortunately, unethical therapists are very uncommon, though ineffective therapy is still possible. Therapy should help you to feel more positive and hopeful about the future, rather than worse. It should also be built on a foundation of trust, making breaches of trust harmful to therapy. Fortunately, there are some specific warning signs you can use to catch bad therapy early and cut off future sessions.

Therapists should always be respectful of your identity, comfort, and safety. If they disrespect you as a person or insult your identity, this is a bad sign. Your therapist should care if you become uncomfortable with the therapy and try to help correct it. Even more than that, they should always commit to providing a safe space for you to exist and speak. This is particularly important if you have experienced trauma in the past.

Therapists should also never use you to resolve their own problems. This typically reduces trust and doesn’t respect your time or money. It also breaches professionality and shifts the therapeutic relationship into more of a friendship. Worse, any therapist attempting to make threats or sexual advances needs to be dropped immediately and reported.

In any of these cases, it is always reasonable to contact the therapist’s supervisor. If they do not provide their supervisor’s contact information or it is not available otherwise, do not work with them. Fortunately, you always have the power to leave bad therapy as an adult and seek a better therapist.

I’m ready to look for therapy. Now what?

Good job! I’m glad the horror stories haven’t scared you off. Now that you know what to watch for (good and bad), it’s time to actually look for a therapist! There are two main ways to find a therapist to work with.

First, look to your insurance or contact them directly and ask for a directory of in-network providers. Insurance companies (particularly in the US) should provide these on request, allowing you to find a therapist covered by them. If that doesn’t work, the second option is to use an online directory such as PsychologyToday’s directory. These can be filtered by specialty and provide a wide range of possible therapists to choose from. On the website, they also typically specify what types of insurance cover their services.

If therapy seems too expensive, you can often ask if they have sliding-scale or equity-based pricing. Therapists tend to want to help people and offer lower prices based on your situation as a result. It is always worth asking, if you don’t have much income. If a therapist doesn’t have any sliding-scale slots available for you, they will typically refer you to other resources.

Small note:

In addition to linked sources, this article is based on interviews with therapists about their recommendations. In addition, it uses information collected from many client experiences with therapy and what they found helpful vs unhelpful. Always remember to pay attention to your own experiences and feelings when seeking out and participating in therapy!

If you found this article interesting or helpful, please consider donating to my ko-fi! Every bit helps, and monthly contributions in particular will help me continue writing articles like these every week.

Alternatively, I provide inexpensive personal coaching for managing executive dysfunction and would love to help you if you need it! I also have a wealth of experience supporting people with ADHD, Autism, and those from the LGBTQIA+ community. Remember, coaching is not therapy, but is focused on specific actionable steps to improve symptoms. It works best in tandem with therapy for working on causal problems. If you would like to work with me, you can check my prices here and contact me here. I look forward to hearing from you!